Hi everyone.
I recently came accros with a book "the way out" by Alan Gordon who explaines how "pain reprocessing therapy" can be an effective treatment for chronic patients. In fact, there is a recent study published in JAMA that found that close to 66% of low back pain patients reported nearly zero or zero pain after the end of that therapy.
Well, he pointed out that almost every chronic pain is in fact neuroplastic which means that the brain missinterprets safe signals as pain. As far as I know something similar happens in fibromyalgia, so I was wondering if maybe somebody has tried that therapy and if it was helpful or not.
Thanks in advance
I haven't tried Pain Reprocessing Therapy as such, but it sounds somewhat akin to the work I did with a neuropsychologist last year. He worked with me on the idea that fibromyalgia pain isn't a threat. Normally, we feel pain, and have a motivating stress response that would help us move away from or counteract the cause. With fibro, we can't proactively tackle our pain in the moment, so we tend to get stuck in the stress response indefinitely. His approach was to help me train myself that there is no threat, interrupting the physiological stress cycle that I was stuck in - and with it the negative health impacts and symptom triggering that stress likes to carry along for the ride.
His approach featured meditation and breath work - aiming to down-regulate the sympathetic nervous system and up-regulate the parasympathetic nervous system. It also involved getting me to perform body scans, acknowledging the presence of pain wherever I found it, but also decisively recognising that it wasn't a danger to me, and could come and go as it pleased. Finally, we went through talk therapy, working through stress sources in my life and exploring positive and negative triggers that I could then harness, manange, or avoid.
I was so impressed by how much this helped me - when combined with a number of other good practices and a few supplements, the result was that my pain is now a fraction of what it used to be. So, I guess I'd say that you could try pain reprocessing therapy, or explore developing your own strategy based on its principles. Definitely worth a shot!
I love what Jemima's doctor taught her. It makes so much sense. My approach was different, but ended in the same place, which is being easy and relaxed with the pain and not allowing it to affect me emotionally. This was a process, and didn't happen overnight, (and of course I am not 100% perfect at it even now), but it is the one thing that I think has helped me the most with chronic pain. More than medication or anything else, the ability to roll with the pain and not have an emotional reaction to it has made it possible for me to manage it daily and have a life.
Jemima mentions in other posts the concept of "Radical Acceptance". I love that phrase, as it is what I have been practicing for years without having such a cool name to call it. It is accepting completely what is in this moment. Acceptance is not approval, or apathy, or acquiescence. It doesn't mean you don't do whatever is in your power to change it and/or deal with it. What it means is you don't waste energy on worry, speculation, dire thinking, or saying that "this shouldn't be happening" or "why me?". All of those things derail your energy from being able to manage it well. "Pain reprocessing therapy" may utilize some of this philosophy as well. I'd like to know more about it.
I love biofeedback. You can do some of this on your own, no need for a program or for fancy equipment. I have found it amazing for my anxiety attacks, and now I employ it every time I start to have one. I think something like that would also work at least to some degree with other things like pain, although I haven't figured out how yet.
Hi LuisC, good question!
Sounds new, but I've read up (sources below) what exactly is entailed in comparison to things we've spoken about here often, and it is - it's also the same as what @Jemima and @sunkacola describe above, reducing pain by not considering it as threat. In his 7' youtube demonstration he says things like "I'm safe"; it's the brain"overreacting")...
His "neuroplastic" pain is the same as the still widely accepted "nociceptive" pain and CSS, which tries to explain hyperalgesia and allodynia and even FM generally *. Neuroplasticity suggesting its reversibility tho. * Neuro-pain experts tend to think FM "is" a CSS = Central Sensitivity/Sensitization Syndrome rather than an autoimmune, mast cell or ATP problem, the other main 3 hypotheses).
Bottom line for me - been there, done that, doesn't help me any more than I've been doing already. I also disagree with the hypothesis that this pain type explains FM, at least not my kind. But at the same time I think it important that "everyone" does it (more than just trying). PRT is actually strongly related to CBT (cognitive behavioural therapy), I'd even say a form of it, which I've done lots of and helped me generally, and also has more research evidence than many other things for it helping with FM. So in that sense and from what I've read up to now it's not new at all, but similar to Kabat-Zinn's Full Catastrophe Living etc.
I do use it, but for me it mainly works by enabling me to tolerate tough local pains. And pain isn't a/the problem for me, had it all my life. Doing this doesn't stop local pains from e.g. waking me up at night and it doesn't do anything for my whole body Ache which if I ignore by overdoing it will make me hurt more and more, making me stumble, drop things & less and less able to move. So less like Jemima, more like sunkacola, it unfortunately doesn't actually reduce my pain. On the other hand I got/get my back pain down by daily back exercises and my other pains down by professional acupressure - which would mean it is physical, so not nociplastic, but the normal type = nociceptive, just that the cause isn't visible on any scans.
Gordon himself was involved in the JAMA study, and as "PRT" is his "cutting edge" baby , and this the first study specifically on that, I'd be interested if these results can be replicated... OTOH considering it's CBT, that's well evidenced.
Sources I've used: the JAMA Psychiatry study (Sep21) and articles about it, Gordon's painreprocessingtherapy institute website, a long youtube interview by Bialik (= Big Bang "Amy"), a 7' youtube live demonstration by him (Unlearning Pain with Pain Reprocessing Therapy - Demonstration) linked on thismighthurtfilm com.
Due to randomized selection (which decreases selection bias) we're talking about 50 people getting the PRT, 10 getting placebo and 5 getting nothing, I'm not sure why the latter two were so few, as these were selected from 3x50.
Pain amount went down from 3-5 (had about 10 years) to 0-2.5 (in the placebo group 0-4.5), after 1 year that remained the same: 0-3.
Their pain went down from a mean of 4.1 to 0-1 out of 10 (that's what the study itself (= PMC8482298) says, one article says "mild to moderate", another says "at least 4", both of which are misleading/wrong, as the standard deviation of 1.26, which means most had roughly a pain of 3-5. This is the reported pain amount before the 4 weeks, which as we know is very subjective (= for me maybe 1-2 of 7, not much by my standards, it's the pain I get before peeing when it's fairly well under control). Afterwards the PRT people had a mean of 1.24 (0-2.5) and the placebo group 2.84 (0-4.5)
2 articles aren't clear on how severe the pain of the people concerned was before
151 men and women who had back pain for at least six months at an intensity of at least four on a scale of zero to 10. (sciencedaily )
vs. nih.gov: 51 people with mild to moderate chronic back pain for which no physical cause could be found
The study itself (PMC8482298) says "mean (SD) pain of low to moderate severity (mean [SD] pain intensity, 4.10 [1.26] of 10" which means
Very interesting, I would certainly like to calm my nervous system down and get some sense of agency over reaction to pain. It can feel like one way traffic once Fibro has taken hold of life. It makes sense telling ourselves it's okay to calm down and observing things as they are, but frustrating when the pain continues regardless. I'll carry on with daily meditations and hopefully learn more about what could help in future.
Very interesting, I would certainly like to calm my nervous system down and get some sense of agency over reaction to pain. It can feel like one way traffic once Fibro has taken hold of life. It makes sense telling ourselves it's okay to calm down and observing things as they are, but frustrating when the pain continues regardless. I'll carry on with daily meditations and hopefully learn more about what could help in future.
Hi Badger...I think that the frustration for you is "the pain continues regardless". This is the point at which the radical acceptance comes in. If you are thinking "gee, I am doing this and the pain hasn't left", then you are focusing on the end result, and what you want, which is for the pain to leave.....because it shouldn't be there. Do you see what I mean? If that is your focus or your ambition then you are not practicing radical acceptance.
It's not an easy concept to get at first, or even after years of practice. Acceptance lets go of outcome. Acceptance doesn't even think about outcome, because outcome is the future, not this moment. True acceptance practice means accepting that the pain IS, in this moment. And is in the next, and so on. That's all. If you can do this, and not think about results or destinations, but stay in the moment, then you can find acceptance.
Now, I don't manage to go around staying in the present moment all the time because I am not enlightened or anything. But having practiced acceptance enough over years, I usually do not need to do it consciously. If I find myself in pain, my emotional reaction is neutral (most of the time) because I do not expect anything different. I don't expect the pain, either. I don't expect. I just accept. So, pain woke me last night and I didn't get enough sleep on a day when I really needed to......oh well. So, today may be harder for me. OK, I will deal with that. By not attaching emotions like anger or frustration or disappointment to what is happening I have more of my depleted energy today to do what I need to do.
Hi Badger...I think that the frustration for you is "the pain continues regardless". This is the point at which the radical acceptance comes in. If you are thinking "gee, I am doing this and the pain hasn't left", then you are focusing on the end result, and what you want, which is for the pain to leave.....because it shouldn't be there. Do you see what I mean? If that is your focus or your ambition then you are not practicing radical acceptance.
It's not an easy concept to get at first, or even after years of practice. Acceptance lets go of outcome. Acceptance doesn't even think about outcome, because outcome is the future, not this moment. True acceptance practice means accepting that the pain IS, in this moment. And is in the next, and so on. That's all. If you can do this, and not think about results or destinations, but stay in the moment, then you can find acceptance.
Now, I don't manage to go around staying in the present moment all the time because I am not enlightened or anything. But having practiced acceptance enough over years, I usually do not need to do it consciously. If I find myself in pain, my emotional reaction is neutral (most of the time) because I do not expect anything different. I don't expect the pain, either. I don't expect. I just accept. So, pain woke me last night and I didn't get enough sleep on a day when I really needed to......oh well. So, today may be harder for me. OK, I will deal with that. By not attaching emotions like anger or frustration or disappointment to what is happening I have more of my depleted energy today to do what I need to do.
Thank you that's very interesting, it's definitely one of the hardest parts for me and I shall be looking back at your post as I read into the subject more. Acceptance is something I've been thinking more about but find difficult to connect with. I've listened to discussion in the Waking up meditation app as well as YouTube, hoping to gain some traction. Some changes in the past couple of years seemed to help, but it can still be very unsettling.
Learning this kind of Acceptance is usually not easy for most people, but with practice it can be done and it is so very helpful that it is worth the work.
One thing that might help is to close your eyes for just 30 seconds or less and repeat to yourself : This is what is, in this moment.
Or, some other words that work better for you perhaps.
Don't know if that will help or not, as I have not used that technique myself. But it might.
Meditation techniques help people with this as well. Again, I cannot offer personal experience since meditation turned out to be not my thing at all.
Other possibilities/techniques for this are the more physical types of relaxation, incl. a "body scan", progressive muscle relaxation, autogenic training, Yoga Nidra etc. With their help we can learn to accept or tolerate better what is in our bodies, the closest Here-and-Now, and one that's hard to distract from. All of these help me more than words (or words alone). For acceptance as well as its contradictions, like anxiety.
I tried different types of meditation during a pain management course in 2007 but didn't stick with it. Feeling sick through stress I tried mindfulness meditation in march 2019 and have practiced daily since. Work in progress but it's been worth doing and I'd like to make the most of it. Had a couple of Yoga Nidra sessions with YouTube this week out of interest. Occasionally I catch myself snoring if I try an afternoon session with a relaxation track. Will be trying to apply myself in future and see what happens in case it helps. There's certainly a lot of tension and stress that's been held on to.
, and this the first study specifically on that, I'd be interested if these results can be replicated... OTOH considering it's CBT, that's well evidenced.
